Evaluating R-CyBorD for the treatment of relapsed non-Hodgkin’s lymphoma

This study evaluated the effectiveness and safety of the R-CyBorD (rituximab, cyclophosphamide, bortezomib, dexamethasone) regimen in patients with relapsed indolent (painless) non-Hodgkin’s lymphoma (NHL). This study concluded that this regimen is effective and well-tolerated in these patients.

There are many treatment options for patients with indolent NHL. These include chemotherapy, immunotherapy, radiation, and combinations of these. However, the best treatment option for patients with relapsed disease remains unclear.

About 20% of patients with follicular lymphoma (FL) experience disease progression within 2 years of diagnosis. These patients tend to have poorer outcomes than patients who relapse later. The CyBorD regimen has been shown to be effective and safe in patients with multiple myeloma. Whether this regimen is also effective and safe in patients with relapsed NHL remains under investigation.

This study involved 21 patients with NHL. 38.1% of patients had FL and 23.8% had lymphoplasmacytic lymphoma (LPL). 62% of patients had stage 4 disease. 81% of patients had two or more prior treatments. Patients were followed-up for an average of 38.1 months.

Overall, 62% of patients responded to treatment. For each NHL subtype, these rates were 88% (FL) and 80% (LPL). 19% of all patients achieved a complete response (disappearance of all signs of cancer). 43% of all patients achieved a partial response (tumor shrinkage).

For all patients, the average progression-free survival (time from treatment until the tumor grows or spreads; PFS) was 11.6 months. The average overall survival (time from treatment until death from any cause; OS) was 54.8 months. At 2 years, these rates were 43% (PFS) and 71% (OS).

Overall, 67% of patients reported severe to life-threatening side effects. The most common included low white blood cell count (33%) and low neutrophil count (white blood cells that fight infections; 38%). Low platelet count (cells involved in blood clotting; 29%) and low red blood cell count (28%) were also reported. 

24% of patients also reported severe numbness or tingling in the hands or feet. This rate decreased to 20% after the dosing schedule for bortezomib (Velcade) was changed. 

This study concluded that the R-CyBorD regimen is effective and well-tolerated in patients with relapsed indolent NHL who relapse after two or more lines of therapy.

This study received funding support from Takeda Pharmaceuticals, the manufacturer of bortezomib.

Also, the patient population in this study was quite small. The number of patients with different NHL subtypes was also small. Larger studies are needed to confirm these results.